19301 POST THIS CARD NEAR FRONT OF BUILDING P TN193O1
P RTI
- CITY OF CUE NO .
INSPECTION DIVISION- JOB INSPECTION RECORD' / G� t�l�
"0 JOB ADDRESS ZO / �--" UNIT# LOT# - CATEGORY -/. CONTROLN
OWNER. 'CONTRACTOR L 0� BUILDING PERMIT INFO
ECORD
OUNDATION/PIERS - DATE INSPECTOR NOTE-ALL GRADNG INSPECONAND DRAINAGE�^ '- :
UFER'GROUND SF TALI:BE INSTALLED TO COMPLY WITH _ JOB DFSCIEPTION
THE APPROVED PLANS AND CITY OF
' PAD/SETBACK-CERT . -
�' CUI'ERTINO STANDARDS. •�
_ "GARAGE SLABS PRBGUNITE �
- -
"POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND/SLAB- INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL h "
MECHANICAL ' - -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING -
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR
INSULATION - -
PLACE-NO SIIBFLOORUNTIL ABOVEHAS BEEN SIGNED.
ROUGH "
PLUMBING
TUBS&SHOWER PAN-
MECHANICAL
ELECTRICAL JACUZZI BOND
FRAMING STAIRS
INSULATION/VENTILATION _
• EMERG.EGRESS - -
SEWER WATER - - -
COVER NO•.WORK"""UNTIL,ABOVE HAS BEEN SIGNED.
EXTERIOR SHEAR HOLD DOWN _ -
INTERIORSHEAR/HOLD DOWN " -
SI-IEETROCK/SHEETROCK SHEAR
EXTERIOR LATI-I/W-SCREEN -
-
SHOWER LATH �a ,
SCRATCH COAT - -
NO'TA'PF•.OR PLAST RSUNTIL ABOVE HAS BEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID -
FINALS I DATE INSPECTOR -
.. SAN.#
ELECT.ENERGY
PLUMBING ENERGY -
MECH.ENERGY
BUILDING ENERGY
_ ELECT:FINAL TEST _
PLUMBING ,
CAS TEST -
MECHANICAL ..
1-ICATING 7ELECTRICAL RELEASE' ' -
GRADE _ ..
OCCUPANCY "
TEMPORARY APPROVALS
ELECTRIC
GAS - -
BUILDING - J;•~.-
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE
BUILDING FINAL IS SIGNED RY BUILDINC. INSPECTOR -
ARRANGE FOR INSPECTION BY PHONING 252-4505 f BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED,INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING:
IMPORTANTI
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY: + -
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY
�I
Building Project Identification - , a'., PERMIT NO.193.01..
o�aa S t e
fJw ere a - Phone: - A
7 — s CITY OP CUPERTINO-BUILDING DIVISION j- /�. �• -�
:09or'a Nar Gc.No. APPLICATION /,PERMIT
�I Architect/Engineer. - BUILDING-ELECTRICAI.PLUMBINC MECIIAMCAL CATEGORY CONTROL N
Lic.No:
.iELECTRIC PER MIT 'FEE - • BUILDING PERMIT INFO-
Address: +' - PERMITISSUANCE El Elp
1' LICENSED CONTRACTOR'S DECLARATION
]hereby affirm that l am licensed under provisions of Chapter 9(commenc- APPLIANCES-RESIDENTIAL ]OB DESCRIPTION -
IngwithSedion7000).MD i,ion3ofthe BusinemandProfesslonsCode,andmy -
-IicenseisinfuR(omeandeffect. PANELS
License Class LieN
rl•I� F1 1-�^"I�
Data Lie.
- , l J /til
ARCHITECPS DECLARATION201-1000 AMPS '
o' Licensed Professbral Z I understand my plans shall be used as public records. OVERIODOAMPS SQ Fr.FLOOR AREA - $/SQ.FT
� .
gipp�±± SIGNS ELECTRICAL: u
Fi � � - - ;' '
I�<< OWNER-BUILDER DECLARATION SPECIALCIRCUFE/MISC
Iherebyafflrmthallamexemptlromthe Contractoraldcenm Ul forthe -
'Z following reason.(Section 7031.5 Business and _
oo g (Se n r,Professions Code.Any city
O Zu9 countywhkh requlresapermitto corutmct,alter,improve,dennWh,or repair T�P.METEROR POLE]NST., '
g���''u a nyslmcturepriortoitsissuares,a)sorequlose the applicant for such permit to I.
E5 O file a signed statement that he V licensed pursuant to the.proNsime o! the POWER DEVICES
3w Contractors License Law(Chapter 9(cormnencin SWIMMING IY)O
with Section 7000)of Divi=
�.0 sion 3 of the Business and PeracmbwCods)or that he is exemptlhere(rom and L ELECTRIC
VALUATION
O 5 the basis for the alleged exemption. Any violation of Section 7031.5 by any '
applicant fora perrNOITILE'(S5WITCFIFSt subj"the applicant to a civil penalty of not rrorethen OQ
JI ve dre1,aso demodollarhere - SQ. - STORIES TYPE CONSTRUCTION
R ' -JrNEW RESIDENTIAL ELEI FC.
I,as owner of the property,omy employees with wages r their sok
7a compeneallon,wllldothe work.and/heslructure is not or offend for
O sale(Sec.7044,Business and Profemims Code.The Contractors License Law ]
r^� does not apply to an owner of properly who builds or improves thereon,and
3^ who does such work hirraelforthrough his own employee,,provided that such OCC.GROUP .RES UNITS
improvements arenotln{ended oroffened forsale.If,howevegthebulldinger TOTAL: �,�,�
mprovereentissold within oneyearofcompietion,theowner-buRderwill have
lhgpurden of proving that he did net build or Improve for purpose of sale.).' QTY, PLUMBINC PERMIT ' FEE - FLOOD ZONE APN
I,as owner of the property,am exclusively contracting with.11mnsed PERMIT ISSUANCE
root coon to construct the project(See.7044,Business and Professions Code: ,
The Contractor's License Law does net apply to an owner of property who , ALTER-DRAW k VENT•WATER(EA)
.bunds or Improves thereon,and who contract, for such projects with . V FEE SUMMARY '
cgplfa&or(.)licensed purouant to the ContratlorY License Law. BACK FLOW PROTECT.DEVICE' '
IJ I am exempt under Sec. B 4 P C ar thy$ nOUTSIDE FEES
/. N - /... n' I /in DRAINS FLOOR A00$ARFA,COND - SANITARY - Y N
. Owner RECFR'f N
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOLTAX Y_ N
❑I hereby affirm that 1 have onlas car of consent to seR-ineure;ora - RECEIPT N
rerttflLab of Workers Comperwtlonlwuvnce oramnifled ropythemo((Sec. GAS FA.SYSTEM-1 INC,40UTLEm
3olicyN J i - PARKFEF Y_ N
RECEIPT a
ceffs - GAS EA.SYSTEM.OVER 4(EA) DING DIV
Com any V BUILDING DIVISION FEES
❑pCertlfled copykhereby furnished. GREASE/INDUSTRLWASTE INTERCEPTOR - PLANCHECK FEE:.
-❑Certified copy is flied with the city Inspection division. _ .,
'CERTIEICATEOF E3( MPTION 17ROM WORKERS'- GREASE TRAP �, - PAID
COMPENSATION INSURANCE, SEWER-SAMTARY-STORM EA.MEET, Dell -Recei I# :
.(This section need not be completed if the permit k for one hundred dollars
($100)er.less.) wA'rntHEATIR WiVENT/Ei.Ixra ENERGY FEE Y N'
I certify that In the performance of the work for which this permit is issued,
I shall not employ any person in any manner so m to become subject to the WATER SYSTEM/TRGTING
Workers'Compereation Laws of California.Date PAID
Z Z' Applicant - x NEW RESIDENTIAL PLMB. SQ.FT. Date .Rece3 f#
O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you
should become subject to the Workers'Coropereation provisions of the Labor ' ' TOTAL
Codqyoumustfahwithromply,[thsuchprovisionsorihispermltahallbc r ILD] G
LU > deemed revoked. - _ ,. '
d c CONSTRUCTION LENDING AGENCY - SEISMIC FEE
I hereby afllrmthat there is a construction lending agency for the perform- ELEC'T'RIC FEE
Zanceoftheworkforwhkhthispermdlsissaed(Sec.3097,CIv.C.) { TOTAL: �C
-U O• LendereName PLUMBING FEE
LL I- Lendcr9Address QTY. MECHANICAL PERMIT , FEE MECHANICAL FEE'
O W' Irertlfythatl have read this applkatlenand statethattheabove information i ' . .
1 Is correct.I agrecto comply with aBUty and county ordinances and state laws PERMIT ISSUANCE _ F�EE�S•'PA�Ia?.�:
N relating tobullding emotruction,and hereby authorize representatives o(thls
I— Z citytoenterupon the above-mentioned property for lnspeNon purposes. - ALTER OR ADD TO MECH. ' ��a—����
(we)agree to save,indemnify an d keep harmless the City of Cupertino - - Dale I(CC2jP1#
V againstliabilities,prdgments,costsand expenses which may In any wayaccrus AIR HANDLING UNIT cro 10000 CFM) SUBTOTAL:
against said City in consequence of the granting of this permit.
- AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of Applicant/Contractor - Date EXHAUST HOOD MI DUCT) CONS1TRUC21ON TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE ,939 ,'.-.
Will the applicant or future building occupant store or handle hazardous" IIEATINGUNI H0100,000BTU)
- imaterial as defined by the Cupertino Municipal Code,Chapter 9.12,and the Dete ,RICE] I#
He❑alt,annd Safety Code,Secton 25532(a)? HEATING UNIT(OVER 100,000 BTU) .TOTAL: ZI®
Will the applicant orfuturebullding occupant use equipment ordevicas_ VFN7ILATION FAN(SING LE RESID) ISSUANCE DA'L'E .
which emit harardouasirconlamindnlsas defined bytho Bay Area Air -
QualityManagementDistrict? - BOILER-COMP(3HPOR 100,000 BTU) -
-. ]�Yes ®No r '
Shave read the hazfrdods materials requirsencoue under Chapter 695 of BOILER-COMP(OVER 100,000 BTU)
the California Health&Safety Code,Sections 25505,75533 and 25534.I -
understandthatlfthe building does not currently have a tenant,that It is my NEW RESIDENTIAL MECH. SQ.FT., -
rexponsini ty to notify the occupant of the requirements which must be met
prior to ss,a CertiRcate otOmpanry. /� I
�or aut�gent Cars ISSUEDB -
TOTAL:
OFFICE COPY